Dr. Janis P. Bellack, Journal of Nursing Education
Aug 8, 2014
Janis P. Bellack, PhD, RN, FAAN, is the president of the MGH Institute of Health Professions and is recognized as a John Hilton Knowles Professor. She is also the editor in chief of the Journal of Nursing Education, a top-ranked peer reviewed nursing education journal. Her work focuses on curriculum development, inter-professional relationships, and the evaluation of nursing education programs. We had the honor of speaking with her about her professional career in nursing and her thoughts on the future of nursing education.
What interested you in a career in nursing?
It is always interesting to be asked these questions because you sort of forget after a while. I recall that I was interested in nursing as a young child. I had a T&A (tonsillectomy & adenoidectomy) at age 3. I was in a hospital overnight, and I remember being fascinated by the nurses. I found them to be very caring and concerned about me as well as proficient. As I grew older, I wanted to become a high school teacher and teach English, but my mother tells me that even at age 5 I asked for a nurse’s kit and a cape from Santa. When I got ready to go to college, I decided I was eager to get into nursing so I searched for programs and I ended up going to a hospital-based diploma program at UVA. I was actually in their last diploma class, and I stayed on for 2 more years to receive my Bachelor of Science in Nursing degree at the university. I combined my love of liberal arts and teaching with my love for nursing.
It seems that more nursing students are pursuing advanced degrees. Can you describe how you managed to combine your career in medicine with your interest in education policy and practice?
From very early on I was interested in both the practice of nursing and teaching. After I became an RN, I practiced for about 3 years full-time but decided I really wanted to teach. That’s what motivated me to go back to school to get a master’s degree, which was a required credential for any university-based program. Fortunately, I was able to practice about 24 hours a week when I went back to school full-time. I went to University of Florida for my master’s degree so I was able to practice in the county hospital emergency room and, after I got my degree, I went back to UVA for my first faculty position. While I was there, it was becoming apparent to me that a doctoral degree would soon be required, especially if I wanted to advance within the university’s academic ranks. At the time, I had been married and had my first child. My husband wanted to get his PhD in psychology so we ended up moving to Lexington, Kentucky, where I got a full-time position teaching at the University of Kentucky College of Nursing and we had our second child. I decided to go back to school part-time to get my PhD at UK while teaching full-time and being a mom of two preschoolers.
At the time, a PhD program in nursing was not available at UK, but over the years, as I had been a faculty member, I had become very interested in higher education policy, curriculum development, teaching strategies, academic governance, etc. I found out that there was a PhD program at UK that was a perfect fit for me - higher education policy. The program was rather unique because it was designed to welcome PhD students who had not had an undergraduate background in education with the goal them to apply what they learned back to their “home” discipline. I had the great benefit of being able to craft my coursework and dissertation to my primary discipline of nursing. Many people complain about their PhD program, but I loved every course I took and it opened up an entirely new world and new ways of thinking for me.
As president of the MGH Institute of Health Professions, what do you believe is the biggest challenge to students interested in nursing?
I think that the biggest challenge is that it has become very, very competitive to get into a baccalaureate degree nursing program. It has been clear for a number of years that a bachelor’s degree is the minimum credential needed given the explosion of knowledge and the complexity of patients we care for these days. There are so many well-qualified applicants to nursing programs throughout the country who have the passion to become a nurse but they are turned away because there are not enough spots. Despite the proliferation of nursing programs available and the increased number of spots that have become available in these nursing programs, there are still difficulties related to faculty shortages and a shortage in the number of clinical learning placements.
I think another challenge is the public image of nursing. I think it has certainly improved over the years; the Johnson and Johnson campaign to become a nurse in the early part of the century began to change that view. Some applicants have the belief that if you have a caring personality and the desire to help people, that is enough. This is certainly necessary, but not sufficient. The rigor of the curriculum is often a surprise. Nursing is an academic discipline, grounded in science and very much like medicine in the sense that it is both a science and an art. It is also a different world view than medicine. Medicine focuses primarily on the diagnosis and treatment of disease, which is a critical role for our society. However, nurses are the 24/7 presence, unlike any other health professionals who come and go from the patient and family based on their specific roles and expertise. Nurses oversee and coordinate the “whole”.
Another critical challenge is to help those interested in nursing see the broad range of possibilities for professional practice in settings other than the acute care setting. The setting depicted in ER and House shows that nursing is always fast-paced and hospital-based, but increasingly care is being delivered outside the hospital setting. There are more opportunities for nurses to practice outside the hospital walls, e.g. skilled nursing facilities, rehab settings, ambulatory settings, public health venues, community health centers, schools, Minute Clinics, etc.
You also serve as editor in chief of the Journal of Nursing Education. Based on this experience, what two or three things would you change about the way we train our nurses?
The 2010 Institute of Medicine Future of Nursing report has been pivotal and demonstrates a culmination of 45 years of recommendations and history to move nursing education out of hospitals and into colleges and universities and to do so where there is no less than a bachelor’s degree required. It continues to be a surprise that nursing is the only health profession that does not require a master’s or first professional doctoral degree for entry into practice, especially given the explosion of knowledge and complexity of patients and healthcare. I would change nursing education to make the Bachelor of Science in Nursing degree the minimum degree. I would also change it to focus the curriculum and learning experiences on building a solid foundation in the supporting coursework in basic and social sciences and humanities. I would also place less emphasis on current content and lectures and more emphasis on learning to “learn” - how to access information in the information age, how to make sense of that, how to know what information is useful for evidence-based practice.
As hospital care moves to team-based practice, I think it is imperative that we make sure our curricula and student learning experiences create opportunities for inter-professional teams with physicians and other health professionals. I also think we need to do a better job in nursing programs to help students learn and focus on systems thinking - the role of the nurse as a member of the system responsible for care delivery. A nurse is responsible not only for his/her professional and licensed role, but also for making sense and understanding of systems of care, including such aspects as quality and safety, health policy, Triple Aim, population health, care redesign, and in general, keeping up with the “whitewater” of health care reform, etc. This is important so that nurses are ready to practice in the fast-paced, ever-changing system of health care and health finance.
How you do you foresee the relationship between doctors, physician’s assistants, and nurses change over the next few years?
One thought that immediately came to me was that I prefer to use “physicians” instead of “doctors” to refer to MDs, as mnay other health professionals now use doctor, such as PharmD, DNP, DPT, etc. There is and will be greater blending and overlap of roles depending on the system of care, site of care, patient care, diagnosis and treatment, patient and family preference, cost and reimburstment, etc. We MUST understand, appreciate, and value each other’s respective roles, authority, and contributors for care and work collaboratively as a team. With the Affordable Care Act bringing millions more people into insured care, we must remember that we all share a commitment to improving health and health care. I lament when we have turf battles because we should all keep in mind why we went into our disciplines to begin with - to make a difference to health and health care, to care for people and help them be as well and healthy as they can be, cope with and manage health issues and problems, and/or achieve peaceful end of life care.
All MDs, NPs, PAs, PharmDs, etc. also need to learn how to partner with patients, families and communities in managing their care. I think increasingly we are seeing that the public has so much access to health information, so we need to include our patients as members of the health care team and give them a greater and responsibility in managing their own health, in collaboration with the health professional care team.